Devices for light treatment of wounds to reduce scar formation

ABSTRACT

An electromagnetic energy system configured to reduce scar formation associated with a skin wound includes: an electromagnetic energy source configured to generate an electromagnetic energy beam having a plurality of beam parameters; an optical energy conduit having a proximal and a distal end, said optical energy conduit coupled to said electromagnetic energy source at said proximal end; a handpiece coupled to the distal end of said optical energy conduit; and a memory, comprising predetermined, stored values of said plurality of beam parameters, said predetermined values of said beam parameters configured to reduce scar formation associated with a skin wound.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority from U.S. Provisional No.61/314,560, filed Mar. 16, 2010, which is expressly incorporated byreference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to methods of using electromagnetic energy toenhance wound healing and to minimize or prevent scar formation.

2. Description of the Related Art

Fractional electromagnetic energy is used to treat a variety of skin andtissue conditions and pathologies. Such treatments typically employlight-based devices such as lasers and RF devices to deliver energy tothe epidermis and/or the dermis of a subject's skin. Controlledapplications of light energy penetrate to various depths of the skin.Energy penetration results in localized heat deposition through thesubsurface of the skin as well as localized thermal damage within theepidermis and/or dermis, depending upon the depth of penetration.Thermal damage within the skin at treatment sites and, in some casesthroughout the surrounding adjacent tissue, causes immediate andlong-term, natural healing effects within the affected tissue. Suchnatural healing effects include collagen contraction and stimulation ofcollagen formation, which result in a macro effect of collagenregeneration throughout the underlying skin layers.

A number of skin treatments are possible with lasers and RF devices. Forexample, such device may be used for relatively superficial treatmentsof the epidermal layers for treatment of fine lines, skin texture,pigmentation (dyschromia) and sun damage, as well as deeper treatmentsof the epidermal and dermal layers for treatment of deep wrinkles andscars. Non-limiting examples of such devices are described in U.S. Pat.Nos. 6,328,733; 6,451,010; 6,758,845; and 7,438,712, which are allexpressly incorporated by reference herein in their entireties.

However, a need remains for a safe, effective electromagneticenergy-emitting devices and methods to enhance wound healing and reducescar formation.

SUMMARY OF THE INVENTION

In one embodiment, a method of reducing scar formation associated with askin wound, includes: providing an electromagnetic energy source;delivering energy from the electromagnetic energy source to opposingedges of a skin wound; and sealing the wound after delivering theenergy. The electromagnetic energy source can include a laser, afractional laser, or a CO2 laser.

The method can include scanning a pattern of treatment spots over atreatment area around the skin wound. In one embodiment, the treatmentarea is circular with a diameter in a range of from about 1.3 mm toabout 20 mm, or about 10 mm. The delivering energy can includedelivering laser light having a wavelength in a range of from about 9400nm to about 11100 nm, delivering laser light in a range of from about5.2 J/cm2 to about 445 J/cm2, delivering laser light having a pulsewidth in a range of from about 20 microseconds to about 1000microseconds, delivering laser light having a spot density in a range offrom about 5% to about 100%, and/or creating a plurality of channels inthe skin around the wound, each channel having a depth of about 40microns to about 1500 microns.

The sealing can include suturing the wound closed, delivering a surgicalstaple to skin near the skin wound to close the wound, delivering atissue glue to the skin wound to close the wound, and/or tissue welding.

The method can also include everting the wound prior to deliveringenergy from the electromagnetic energy source. The method can alsoinclude delivering additional energy from the electromagnetic energysource to opposing edges of the skin wound after sealing.

In another embodiment, a method of reducing scar formation associatedwith a skin wound includes: providing a laser system comprising a laserand a scanning handpiece optically coupled to the laser, the scanninghandpiece configured to direct laser energy from the laser to atreatment area on a patient's skin to form a plurality of spots on thepatient's skin within the treatment area; aligning an aiming beamemitted from said handpiece with respect a wound on the patient's skin;activating the laser and handpiece to direct the laser energy from thelaser to the treatment area on the patient's skin to form the pluralityof spots on the patient's skin, wherein said treatment area comprises atleast first and second portions spaced apart from each other and locatedon opposite sides of said aiming beam such that at least some of saidlaser energy is delivered to skin near the wound's edges; and sealingthe wound after scanning said laser beam within the treatment area. Thefirst and second portions can be spaced apart from each other by about awidth of the wound or by at least the width of the wound. In someembodiments, the spacing between the first and second portions ischanged based upon the width of the wound. For example, in someembodiments, the spacing between the first and second portions ischanged automatically based upon the width of the wound, for example, bya sensor located in the handpiece that optically or mechanically sensesthe wound's width.

In another embodiment, an electromagnetic energy system configured toreduce scar formation associated with a skin wound includes: anelectromagnetic energy source configured to generate an electromagneticenergy beam having a plurality of beam parameters; an optical energyconduit having a proximal and a distal end, the optical energy conduitcoupled to the electromagnetic energy source at the proximal end; ahandpiece coupled to the distal end of the optical energy conduit; and amemory, comprising predetermined, stored values of the plurality of beamparameters, the predetermined values of the beam parameters configuredto reduce scar formation associated with a skin wound.

The beam parameter can include a pulse width, a treatment area size, atreatment area shape, a spot size, a power level, a fluence, and/or apenetration depth. The electromagnetic energy source can include alaser, a CO2 laser, and/or a fractional laser. The electromagneticenergy system can also include an aiming beam configured to be alignedwith a wound prior to delivering energy from the electromagnetic energysource to a treatment area near the wound. In one embodiment, thetreatment area is spaced a predetermined distance from the aiming beam.The aiming beam can be formed as a line or a curve.

In yet another embodiment, a handpiece for delivering electromagneticenergy to a tissue treatment site to reduce scar formation associatedwith a wound at the treatment site includes: a housing; a connectorattached to a proximal end of the housing; a scanning system located atleast partially within the housing and configured to receiveelectromagnetic energy from an electromagnetic energy source and deliverthe electromagnetic energy within a treatment area at a treatment siteon a patient's skin as a user-controllable pattern of spots within thetreatment area; and a tissue eversion system protruding at least partlybeyond a distal end of the housing, the tissue eversion systemconfigured to evert tissue around a wound at the treatment site prior todelivering the electromagnetic energy.

The tissue eversion system can include first and second legs, wherein adistance between the first and second legs is controllable by a user.The handpiece can also include a sensor configured to determine aspacing between the first and second legs. The handpiece can control adiameter of the treatment area in response to the distance between thefirst and second legs.

The legs can include a material that doesn't reflect a substantialportion of electromagnetic energy incident upon the leg. The materialcan include a non-reflective coating. The handpiece can also include amedication delivery system configured to deliver a medication to thetreatment site during delivery of the electromagnetic energy. Thehandpiece can also include a wound sealing system configured to seal thewound after delivery of electromagnetic energy. The handpiece can alsoinclude a control located on housing configured to activate the tissueeversion system.

In another embodiment, a handpiece for delivering electromagnetic energyto a tissue treatment site to reduce scar formation associated with awound at the treatment site, the handpiece includes: a housing; aconnector attached to a proximal end of the housing; a scanning systemlocated at least partially within the housing and configured to receiveelectromagnetic energy from an electromagnetic energy source and deliverthe electromagnetic energy within a treatment area at a treatment siteon a patient's skin as a user-controllable pattern of spots within thetreatment area; and a medication delivery system located at leastpartially within the housing and configured to deliver a medication totissue around a wound at the treatment site during delivery of theelectromagnetic energy.

The medication delivery system can include a removable cartridgecontaining the medication. The medication can include one or more of adrug, a steroid, Cortisone, 5-fluorouracil, an anti-cancer drug, anantimycotic, an anti-fungal drug, and a liposome. The medicationdelivery system can include a nozzle configured to spray the medicationtowards the treatment site. The handpiece can also include a controllocated on the housing, the control configured to activate themedication delivery system.

In yet another embodiment, a handpiece for delivering electromagneticenergy to a tissue treatment site to reduce scar formation associatedwith a wound at the treatment site includes: a housing; a connectorattached to a proximal end of the housing; a scanning system located atleast partially within the housing and configured to receiveelectromagnetic energy from an electromagnetic energy source and deliverthe electromagnetic energy within a treatment area at a treatment siteon a patient's skin as a user-controllable pattern of spots within thetreatment area; and a wound sealing system located at least partiallywithin the housing and configured to hold closed a wound at thetreatment site after delivery of the electromagnetic energy.

The wound sealing system can include a stapler, a tissue glue, and/or atissue welding system. The handpiece can also include a control locatedon the housing, the control configured to activate the wound sealingsystem.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cross-sectional view of tissue that includes micro channelsformed a result of a fractional treatment using a microablativetechnique;

FIG. 2 is a top view of different patterns of radiation treatment“spots” applied to skin treatment areas, which creates patterns of microchannels through subsurface tissue, such as shown in FIG. 1;

FIG. 3 is a top view of tissue illustrating one embodiment of a methodof pretreatment of a surgical incision site prior to suturing anincision;

FIGS. 4 and 5 are flow charts illustrating methods of treating wounds toenhance healing and reduce or prevent scar formation;

FIG. 6 is a schematic view of an electromagnetic energy sourceconfigured to perform any of the methods to enhance and reduce orprevent scar formation described herein;

FIG. 7 is a top view of tissue treated with a fractional laser energyfrom the electromagnetic energy source of FIG. 6;

FIG. 8 is a schematic view of a user interface of the electromagneticenergy source of FIG. 6;

FIGS. 9 and 10 are schematic views of handpieces configured to deliver amedication, which are compatible with the electromagnetic energy sourceof FIG. 6;

FIG. 11 is a schematic view of a handpiece configured to evert tissuebefore, during and/or after energy treatment, which is compatible withthe electromagnetic energy source of FIG. 6;

FIGS. 12-15 illustrate one embodiment of a tissue eversion systemapplied to a skin wound; and

FIG. 16 is a schematic view of a handpiece configured to seal a woundbefore, during and/or after energy treatment, which is compatible withthe electromagnetic energy source of FIG. 6.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Fractional light treatments of skin and tissue include microablativetechniques that employ, for instance, laser radiation to ablatemicrochannels within the skin layers at controlled depths and widths.Surrounding tissue adjacent and between microchannels does notexperience thermal damage along the microchannels, although thermaleffects are exhibited throughout the layers of surrounding tissue. Thisresults in the noted macro effect, discussed above, throughout the skinlayers and advantageous long-term effects on the structure of the skinlayers.

Referring to FIG. 1, microablative techniques control depths and widthsof microchannels through the mode of laser radiation employed whether ascontinuous or pulsed light radiation. Typically pulsed light 10 isemployed to create narrow and deep microchannels 12 penetrating to acertain depth in the subsurface tissue including the dermal layers, aswell as to create comparatively superficial and wide microchannels 14penetrating into the epidermal layers and to a significantly shallowerdepth into the dermal layers of the subject's skin 16. In addition,microablative techniques control microchannel structure through, forinstance, the selection of laser radiation power, wavelength, energydensity or fluence (Joules/cm2), pulse width, pulse duration, pulse rate(pulses/sec), and the shape and size of radiation treatment areas.

Referring to FIG. 2 and with further reference to FIG. 1, microablativetechniques typically apply radiation treatment to the skin as a pattern18A and 18B of treatment areas or “spots.” The term “spots” as used inthis specification includes any areas along the skin at which radiationenergy penetrates into subsurface tissue or one or more layers of theskin to create micro-ablated channels. As shown in FIG. 1, variousmicrochannel structures 12 and 14 may be created with the selection ofvarious parameters that facilitate microablation. For instance,selection of spot shape or, more particularly, selection of spotdiameter may be used to control the width of the resulting microchannel. Selection of the radiation energy density may be used tocontrol the ablation rate or depth of the resulting microchannel.

As shown in FIG. 2, a given spot treatment pattern 18A and 18B mayinclude a specific spot diameter and a specific density of spots in ascanned treatment area. One scan pattern 18A may include spots havingcomparatively wide diameters with a comparatively high spot density,while another scan pattern 18B may include spots having comparativelynarrower diameters and comparatively lower spot density. The area orvolume of the required or desired healing zone may be adjusted byvarying the density of the treatment spots within a given pattern. Spotsize and spot density of a given treatment pattern thereby produce thepattern of light radiation that creates and distributes multiplemicrochannels throughout subsurface tissue in the given pattern 18A and18B. In some methods, one or more treatment patterns 18A and 18B may beemployed to produce an overlapping treatment pattern 18C that producesdifferent micro channel structures 12 and 14 and thereby provides one ormore microablative effects throughout the layers of skin.

Microablative techniques for fractional light treatment often employfractional CO2 lasers that may emit radiation at wavelengths of up to10,600 nm. In particular, the patterned light radiation as describedabove may be delivered to treatment areas at high fluences (e.g., highenergy density per laser pulse) for facial skin treatment applicationsand lower fluences (e.g., low energy density per laser pulse) fornon-facial skin treatment applications. High energy density per pulseenables deep penetration, for instance, into the dermis of facial skinfor immediate collagen contraction and stimulation of collagenformation.

In one embodiment, microablative techniques employing the patternedtreatment spots described above apply radiation energy to only a smallarea or volume of subsurface tissue relative to the overall scanned areaof skin. A relatively broad treatment area of the skin may be scannedwith a radiation delivery device. Yet, the delivery device emitsradiation energy in a given pattern of treatment spots that appliesenergy to only a fraction of the subsurface tissue underlying thescanned area of skin. Radiation energy is absorbed by the skin andcreates microchannels without exposing the surrounding tissue. Asmentioned, the ablative techniques of micro channel formation createhealing effects throughout the surrounding adjacent tissue that resultsin an advantageous macro effect throughout the subsurface tissue.

In addition to CO2 lasers, fractional light treatment usingmicroablation techniques may also employ iridium lasers and otherlasers. Fractional light treatments also include procedures that may usenon-ablative techniques that may employ general Nd:YAG and other lasersoperative in non-ablative modes, as well as arrays of RF needleelectrodes.

Referring to FIG. 3, in one embodiment, a method of intraoperativetreatment of surgical wounds with fractional microablative lightradiation reduces or eliminates subsequent scar formation after surgicalintervention. Tests employing the fractional microablative lighttreatments discussed above in the context of surgical wound healingindicate significant reductions in scar formation. More particularly,test results show that fractional microablative light treatments ofsurgical incisions with light radiation before suturing results in asignificant decrease in subsequent scar formation.

In one configuration of the method, a fractional CO2 laser was employedto deliver pulsed light energy 24 to each of the edges 20 and 22 of asurgical incision site 26 in facial tissue at the time of excision andprior to suturing. The surgical sites 26 were a minimum of about 2 cm inlength. The treatment spot was about 10 mm. The treatment spot includedan overlap between adjacent treatment spots of about 5 mm.

Other parameters of the laser beam produced with the fractional CO2laser employed in the surgical wound pretreatment include lightradiation having wavelengths in a range of from about 9,400 nm to about11,100 nm, and energy density or fluence in a range of from about 5.2Joules/cm2 to about 445 Joules/cm2 that was delivered with a pulse widthin a range of from about 20 μs to about 1000 μs.

The treatment area can include about 1.3 mm to 20 mm of scan area andfurther included a spot density of between 5% and 100%. A penetrationdepth is estimated to be in the range of from about 40 μm per pulse toabout 1500 μm per pulse.

One study performed according to one embodiment of the inventionincluded ten Mohs micrographic surgery patients. Surgical incision siteswere treated intraoperatively with a fractional CO2 laser in arandomized split fashion whereby half of a given incision site wastreated with microablative light treatment and the remaining half of theincision site was left untreated before the incision site was sutured.The patients were seen and the incisions were photographed within oneweek of surgery and thereafter within two to three months of surgery.Scar questionnaires were completed at that time. Three physicians servedas blinds to evaluate and rate the incision photographs.

The results indicate that eight of the ten patients had a significantimprovement in the half of the incision sites that were treated with thefractional CO2 laser energy. Excellent agreement between patientobservations and the blind physician ratings occurred.

The results indicate that the fractional CO2 treatment of the incisionedges 20 and 22 at the time of excision, and prior to suturing of theincision, is significantly effective for minimizing the appearance ofsubsequent scar formation compared to the control surgical sites thatdid not receive such pretreatment.

The results further suggest that applications of high fluences of CO2light energy to facial wounds enhance wound healing and help to reducescar formation subsequent to surgical procedures.

The results also suggest broader applications of fractional CO2 lighttreatment to reduce scar formation after surgical intervention ofnon-facial tissue. In these cases, the fractional CO2 light treatmentmay be delivered at lower fluences. In addition, the results suggestthat applications of fractional CO2 light treatment for non-surgicalwound healing of both facial and non-facial tissue may be effective.

The therapeutic methods described herein may be performed with a varietyof electromagnetic energy-emitting devices, including lasers, intensepulsed light, radiofrequency (RF) energy sources, as well as others.Indeed, iridium, erbium (e.g., Er:YAG and/or Er, Cr:YSGG), neodymium(e.g., Nd:YAG), and a variety of solid-state or diode laser devices maybe employed to delivery light energy to surgical and non-surgical woundsto enhance healing and to help to minimize or prevent consequent scarformation according to any one or more of the methods discussed herein.

The invention also anticipates that other non-ablative light energybased treatments may be employed and may be effective fractional lighttreatments for enhancing surgical and non-surgical wound healing and forminimizing scar formation. For example, any laser configured foroperating in a non-ablative fractional mode may be effective. Otherelectromagnetic-energy-based devices, such as RF electrode needles, mayprovide effective results, as well.

Another embodiment of a method of enhancing healing and minimizing orpreventing scar formation is illustrated in FIG. 4. The method 40 beginsby performing a surgical incision at block 42. The incision may beperformed using any of a variety of techniques and with any of a varietyof devices, including a scalpel or laser. At block 44, electromagneticenergy is delivered to the margins of the tissue located at the incisionsite. For example, electromagnetic energy may be delivered to the edgesof tissue (e.g., skin) on opposite sides of an incision.

The electromagnetic energy can be delivered with a scanning handpiecethat scans a treatment beam over a treatment area and delivers asequence of overlapping, abutting, and/or spaced-apart energy spots tothe treatment area. In one embodiment, the electromagnetic energy sourceincludes a fractional energy source, which spaces treatment spots apartfrom one another, for example, in the manner illustrated above withrespect to FIGS. 1 and 2.

The method 40 proceeds to block 46, during which the clinician closesthe surgical wound. For example, at block 46 the clinician may suture,staple, glue, or weld the treated tissue to close the surgical wound.Optionally, the method can further include an additional block (notshown), during which the clinician delivers a subsequent electromagneticenergy treatment to the closed surgical wound.

Another embodiment of a method of enhancing healing and minimizing orpreventing scar formation is illustrated in FIG. 5. The method 50 beginsby performing a surgical incision at block 52. The incision may beperformed using any of a variety of techniques and with any of a varietyof devices, including a scalpel or laser. At block 54, a surgicalprocedure is performed. For example, at block 54, a growth, lesion, ortumor is removed from the patient's body. The surgical treatment mayinclude removing a portion of the patient's skin and/or removing atissue mass from beneath the patient's skin. The method 40 proceeds toblock 56, during which the clinician closes the surgical wound. Forexample, at block 58 the clinician may suture, staple, glue, or weld thetreated tissue to close the surgical wound. At block 58, electromagneticenergy is delivered to the margins of the tissue located at the incisionsite. For example, electromagnetic energy may be delivered to the edgesof tissue (e.g., skin) on opposite sides of the incision.

The electromagnetic energy can be delivered according to any of themethods described herein with a scanning or a non-scanning handpiece. Ascanning handpiece typically includes one or more movable optics, suchas a spinning mirror, that scans a treatment beam over a treatment areawhile the handpiece is held stationary at a treatment location on thepatient's skin. The scanning treatment beam results in a sequence ofoverlapping, abutting, and/or spaced-apart spots within the treatmentarea. The treatment spots are generally circular in shape, and can bedelivered within a variety of treatment area shapes and sizes, includingsquare, triangular, rectangular, circular, hexagonal, trapezoidal,parallelogram, rhombus, linear, or annular shapes.

In one embodiment, the electromagnetic energy source includes afractional energy source, which spaces treatment spots apart from oneanother, for example, in the manner illustrated above with respect toFIGS. 1 and 2.

One embodiment of a system 60 configured to perform methods of usingelectromagnetic energy to enhance wound healing and to minimize orprevent scar formation is illustrated in FIG. 6. The system 60 includesan electromagnetic energy source 62 that is coupled to a handpiece 66(sometimes referred to as an adapter 66) by an energy conduit 64. Theelectromagnetic energy source 62 includes a power supply 68, a laser 70,a control system 71, and a user interface 72. A user controls theoperation of the system 60 via the user interface 72.

In one embodiment, the laser 70 includes a CO2 laser that emits a beamof light having a wavelength of 10,600 nm. The laser 70 can operate in apulsed or continuous mode, and deliver up to 240 W of power to atreatment site. The control system 71 includes a microprocessor and/orother electronic hardware and software to control system operationaccording to input received from the user interface 72. In oneembodiment, the control system 71 includes a memory configured to storedata or presets relating to one or more beam parameter settings. Forexample, the memory can store predetermined beam parameter settingvalues and it can store user-configurable beam parameter setting values.The beam parameter settings correspond to any of a variety ofelectromagnetic energy, light, and/or laser parameters, including butnot limited to: pulse width, average power, peak power, duty cycle,energy, fluence, treatment area shape, spot density, spot size, depth ofpenetration, etc. The energy conduit 64 includes a waveguide,articulated arm, and/or fiberoptic delivery system to conductelectromagnetic energy from the energy source 62 to the handpiece 66.

The laser beam spot sizes can be controlled to have a variety ofdiameters by adjusting corresponding setting on the user interface 72.For example, the laser beam's spot sizes can be controlled to have adiameter of 120, 200, 1000, 1300, or 2000 μm. The handpiece 66 includesscanning optics to provide fractional lasing of the target tissuesurface.

In one embodiment illustrated in FIG. 7, the handpiece 66 emits analignment beam 76 of visible, non-therapeutic light (e.g., a spot, line,or curve from a red or green aiming beam, such as a laser, Helium Neonlaser, diode laser, light emitting diode, etc.) to help the clinicianalign the therapeutic energy from the handpiece with a surgical wound 74on the patient's skin 75. For example, the handpiece 66 can emit avisible line of light 76 that the clinician can center between the edges75 of a surgical incision 74 prior to activating the laser 70 of thesystem 60.

The alignment beam 76 provides a reference point (or line) with respectto the treatment areas 77 of the therapeutic energy from the laser 70.For example, as illustrated in FIG. 7, the treatment areas can includetwo rectangular areas 77 spaced apart by a predetermined distance 78.The predetermined distance 78 can be selected by the clinician todeliver more energy to the patient's skin 75 and surgical wound's edges75, and less energy to the tissue between the surgical wound's edges 75.

One embodiment of a user interface 80 is illustrated in FIG. 8. The userinterface 80 includes a display area 82, beam parameter controls 84, andpresets 86. The display area 82 indicates to the user the current statusof the system, such as whether it is ready to be activated, whether itis emitting electromagnetic energy, and beam parameter setting, as wellas other useful clinical information. The beam parameter controls 84allow the user to control the therapeutic energy beam emitted from thesystem 60. For example, the beam parameter controls 84 can allow theuser to control the power delivered to the patient's tissue, the shapeand size of the treatment area, the size of the spots delivered by thehandpiece 66, the width of each optical pulse, the temporal and spatialspacing between pulses, the energy density delivered to the patient'stissue, the depth of penetration, the width or diameter of the beamspots, etc.

In one embodiment, the beam parameter controls 84 also allow the user tocontrol the shape, size, color and/or brightness of the alignment beam78 (as discussed above with respect to FIG. 7). The beam parametercontrols 84 can also allow the user to control the number of treatmentareas 78 to be delivered by the system 60, as well as their shapes(e.g., rectangular, as illustrated in FIG. 7) and spacing 78.

The presets 86 are user-selectable configurations that correspond to agroup of beam parameter controls relevant to a particular clinicaltherapy. For example, the user interface 80 can include a preset 86corresponding to “Surgical Scar Reduction,” which when selected wouldset one or more beam parameter controls to predetermined levels, such asthe levels or settings discussed above. The preset 86 adjusts acombination of beam parameters to result in an overall system 60 settingthat provides electromagnetic energy to enhance wound healing and tominimize or prevent scar formation.

One embodiment of a scanning laser handpiece 66 adapted to enhance woundhealing and minimize or prevent scar formation is illustrated in FIG. 9.The handpiece 66 includes a housing 80 and a connector 82 at thehandpiece's proximal end 84. The connector 82 allows the handpiece to beremovably attached to an energy conduit, such as the energy conduit 64of FIG. 6. An optical output 88 is located at the handpiece's distal end86. The optical output 88 can include one or more of an aperture, lens,and window. The handpiece 66 includes a scanning system 90, which mayinclude various lenses, mirrors, and motors to create a fractionaltreatment area on the patient's skin. The handpiece 66 also includes amedication delivery system 92 that is configured to deliver a medicamentto a treatment site during treatment.

For example, the medication delivery system 92 can include a tubing,pump, spray or other device adapted to eject a liquid or cream from ahandpiece output 94 to a treatment site on the patient's skin. Themedication delivery system 92 can include a user-changeable cartridge,such as a single-use cartridge, that includes the medication.

The medication can include one or more of a drug, steroid, Cortisone,5-fluorouracil, an anti-cancer drug, an antimycotic (e.g., anti-fungal)drug, or a liposome. Such substances can help with wound healing andscar reduction and prevention. In some embodiments, the flow rate of themedication is controlled in response to beam parameter controls 84 orpresets 86 selected by the user. For example, in one embodiment, whenthe beam penetration depth, diameter, power, or fluence is increased,the medication delivery rate is increased, as well. Similarly, as theseparameters are decreased, the medication delivery rate is decreased, aswell.

The medication is delivered from the medication output 94 to the tissuetreatment site before, during, and/or after deliver of electromagneticenergy. In some embodiments, the handpiece 66 includes a roller ball orcylinder, or a spatula arm that spreads the medication over thetreatment area during and after treatment.

In another embodiment, as illustrated in FIG. 10, a handpiece 66includes an optical path 94 instead of the scanning system 90 of FIG. 9.The optical path 94 can include a fiberoptic, a waveguide and/orstationary mirrors and lenses (stationary with respect to the handpiece66), to direct electromagnetic energy, such as laser light, from thehandpiece's proximal end 84 to its distal end 86.

FIG. 11 illustrates another embodiment of a handpiece 66 configured toenhance wound healing and reduce or prevent scar formation. Thehandpiece 66 includes a housing 80, connector 82, and scanning system92, similar to those described above. However, the handpiece 66 of FIG.11 also includes a tissue eversion system 100 and control 101 for tissueeversion activation. The tissue eversion system 100 bring opposing edges114 of a surgical wound 112 together such that the skin 110 is intension, and wound edges 114 press against or overlap one another, asshown in FIGS. 12-15.

In one embodiment, the tissue eversion system 100 includes twotissue-contacting arms 102 that rotate with respect to each other abouta pivot 104. Each arm 102 includes a first portion that extends insubstantially the same direction as the handpiece's longitudinal axis,and second, leg portion 106, that extends at an angle of about 90degrees with respect to the first portion. The legs 106 of tissueeversion system 100 are elongated and space apart sufficiently to beplaced on opposite sides of a wound 112, as shown in FIGS. 12 and 13.

Activating the tissue eversion system's control 101 causes one or botharms 102 to rotate with respect to each other, which causes the legs 106to move towards each other, as well. When the legs 106 are contactingtissue 110 on opposite sides of a wound 112, activating the control 101therefore causes the opposing edges 114 of the wound to press againsteach other, and lift or evert a predetermined distance 116, as shown inFIGS. 14 and 15.

Electromagnetic energy is then delivered from the handpiece 66 while thetissue eversion system 100 stabilizes the wound 112 in an evertedconfiguration. After treatment is completed and while the tissue iseverted, the clinician can stitch, suture, or otherwise secure the woundin its closed configuration. Everting the tissue can eliminate theformation of dimples or other noticeable skin changes once the surgicalwound 112 has healed.

In one embodiment, a method of treating tissue with an everting,electromagnetic-energy-emitting handpiece includes: aligning a tissueeversion system with a wound, everting the tissue (e.g., pinchingopposing sides of the wound together to lift the edges), applyingfractional laser energy to the everted wound, and suturing the woundwhile everted.

In another embodiment, the tissue eversion system 100 includes a sensor(not shown) that detects the spacing between the system's legs 106. Forexample, the sensor can include an optical sensor that responds to amaterial or a coating on each leg 106. In another embodiment, the sensormerely keeps track of the distance (or angle) that each arm 102 has beenmoved (e.g., rotated), and then calculates the spacing between thesystem's legs 106.

To avoid directing electromagnetic energy to the legs 106, the tissueeversion system 100 can provide an alarm to the user if it determinesthat the selected treatment area's size is too large, such thattherapeutic energy (e.g., fractional laser light) will be directed tothe tissue eversion system's legs 106. In another embodiment, the tissueeversion system 100 automatically changes the therapeutic treatmentarea's size automatically, for example, as the spacing between legs 106changes.

In yet another embodiment, as illustrated in FIG. 16, a handpiece 66includes a wound sealing system 200. When a control 201 is activated,the wound sealing system 200 seals the tissue wound afterelectromagnetic energy treatment, such as any of the treatmentsdiscussed above. In one embodiment, the wound sealing system includesone or more of a tissue stapler, a tissue welding system, or a tissueglue. Surgical staples advantageously hold tissue edges together withoutstrangulating the blood supply to the tissue, which is one disadvantageof suturing a wound closed. Blood supply is not strangulated by usingstaples because staples enter the skin on opposite sides of the woundand protrude in a primarily linear or slightly curved direction into thetissue. On the other hand, sutures typically wrap around and circle thewound 360°, which can lead to blood supply strangulation and inferiorhealing.

In addition, the handpiece 66 may include more than one of the featuresdescribed herein. For example, the handpiece 66 may include two or moreof a medication delivery system, a tissue eversion system, and a woundsealing system. In some embodiments the handpiece 66 includes all threesystems. In others, the handpiece 66 includes a tissue everting systemand a wound sealing system. In such embodiments, the wound sealant maybe delivered prior to eversion (e.g., apply a tissue glue prior toeversion) and/or after eversion (e.g., deliver a surgical staple orprovide heat, such as laser energy, to cause tissue welding).

Although certain embodiments and examples have been described herein, itwill be understood by those skilled in the art that the presentinventive subject matter extends beyond the specifically disclosedembodiments to other alternative embodiments and/or uses of theinvention and obvious modifications and equivalents thereof. Thus, it isintended that the scope of the present inventive subject matter hereindisclosed should not be limited by the particular disclosed embodimentsdescribed above, but should be determined only by a fair reading of theclaims that follow.

1. An electromagnetic energy system configured to reduce scar formationassociated with a skin wound, comprising: an electromagnetic energysource configured to generate an electromagnetic energy beam having aplurality of beam parameters; an optical energy conduit having aproximal and a distal end, said optical energy conduit coupled to saidelectromagnetic energy source at said proximal end; a handpiece coupledto the distal end of said optical energy conduit; and a memory,comprising predetermined, stored values of said plurality of beamparameters, said predetermined values of said beam parameters configuredto reduce scar formation associated with a skin wound.
 2. Theelectromagnetic energy system of claim 1, wherein said beam parameterincludes one or more of a treatment area size, a treatment area shape, aspot size, a power level, a fluence, and a penetration depth.
 3. Theelectromagnetic energy system of claim 1, wherein said electromagneticenergy source comprises a laser.
 4. The electromagnetic energy system ofclaim 3, wherein said laser comprises a CO2 laser.
 5. Theelectromagnetic energy system of claim 3, wherein said laser comprises afractional laser.
 6. The electromagnetic energy system of claim 1,further comprising an aiming beam configured to be aligned with a woundprior to delivering energy from the electromagnetic energy source to atreatment area near said wound.
 7. The electromagnetic energy system ofclaim 6, wherein said treatment area is spaced a predetermined distancefrom said aiming beam.
 8. The electromagnetic energy system of claim 6,wherein said aiming beam is formed as a line.
 9. The electromagneticenergy system of claim 6, wherein said aiming beam is formed as a curve.10. A handpiece for delivering electromagnetic energy to a tissuetreatment site to reduce scar formation associated with a wound at thetreatment site, said handpiece comprising: a housing; a connectorattached to a proximal end of said housing; a scanning system located atleast partially within said housing and configured to receiveelectromagnetic energy from an electromagnetic energy source and deliversaid electromagnetic energy within a treatment area at a treatment siteon a patient's skin as a user-controllable pattern of spots within saidtreatment area; and a tissue eversion system protruding at least partlybeyond a distal end of said housing, said tissue eversion systemconfigured to evert tissue around a wound at said treatment site priorto delivering said electromagnetic energy.
 11. The handpiece of claim10, wherein said tissue eversion system comprises first and second legs,wherein a distance between said first and second legs is controllable bya user.
 12. The handpiece of claim 11, wherein said handpiece furthercomprises a sensor configured to determine a spacing between said firstand second legs.
 13. The handpiece of claim 11, wherein said handpiececontrols a diameter of said treatment area in response to the distancebetween said first and second legs.
 14. The handpiece of claim 11,wherein said legs comprise a material that doesn't reflect a substantialportion of said electromagnetic energy incident upon said leg.
 15. Thehandpiece of claim 14, wherein said material comprises a non-reflectivecoating.
 16. The handpiece of claim 10, further comprising a medicationdelivery system configured to deliver a medication to the treatment siteduring delivery of said electromagnetic energy.
 17. The handpiece ofclaim 10, further comprising a wound sealing system configured to sealsaid wound after delivery of said electromagnetic energy.
 18. Thehandpiece of claim 10, further comprising a control located on saidhousing, said control configured to activate said tissue eversionsystem.
 19. A handpiece for delivering electromagnetic energy to atissue treatment site to reduce scar formation associated with a woundat the treatment site, said handpiece comprising: a housing; a connectorattached to a proximal end of said housing; a scanning system located atleast partially within said housing and configured to receiveelectromagnetic energy from an electromagnetic energy source and deliversaid electromagnetic energy within a treatment area at a treatment siteon a patient's skin as a user-controllable pattern of spots within saidtreatment area; and a medication delivery system located at leastpartially within said housing and configured to deliver a medication totissue around a wound at said treatment site during delivery of saidelectromagnetic energy.
 20. The handpiece of claim 19, wherein saidmedication delivery system comprises a removable cartridge containingsaid medication.
 21. The handpiece of claim 19, wherein said medicationcomprises one or more of a drug, a steroid, Cortisone, 5-fluorouracil,an anti-cancer drug, an antimycotic, an anti-fungal drug, and aliposome.
 22. The handpiece of claim 19, wherein said medicationdelivery system comprises a nozzle configured to spray said medicationtowards the treatment site.
 23. The handpiece of claim 19, furthercomprising a control located on said housing, said control configured toactivate said medication delivery system.
 24. A handpiece for deliveringelectromagnetic energy to a tissue treatment site to reduce scarformation associated with a wound at the treatment site, said handpiececomprising: a housing; a connector attached to a proximal end of saidhousing; a scanning system located at least partially within saidhousing and configured to receive electromagnetic energy from anelectromagnetic energy source and deliver said electromagnetic energywithin a treatment area at a treatment site on a patient's skin as auser-controllable pattern of spots within said treatment area; and awound sealing system located at least partially within said housing andconfigured to hold closed a wound at said treatment site after deliveryof said electromagnetic energy.
 25. The handpiece of claim 24, whereinsaid wound sealing system comprises a stapler.
 26. The handpiece ofclaim 24, wherein said wound sealing system comprises a tissue glue. 27.The handpiece of claim 24, wherein said wound sealing system comprises atissue welding system.
 28. The handpiece of claim 24, further comprisinga control located on said housing, said control configured to activatesaid wound sealing system.